Wellness Center Court Reservation Form

SEE SOMETHING. SAY SOMETHING.

Larson Wellness Center Reporting Form
The Wellness Center is an unstaffed facility. In order to maintain a clean and safe environment for all, Larson Manufacturing associates and retirees are encouraged to report any issues they observe while utilizing the Center. Possible issues can include:
- Failure to clean up area after use
- Misuse of facilities or equipment
- Inappropriate or unsafe behavior
- Failure to follow rules & policies
- Minors not being supervised
- Abuse of 4 person guest limit
- Guests not signing waiver
- Faulty equipment
All reports will be kept confidential. Please provide name and contact information for follow-up discussion as needed.
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
What type of user are you?*

Current Larson AssociateRetiree
What day and time did you observe this issue?*

MonthDayYear
Date
Hour MinutesAM/PM Option
Please describe in detail the issue or behavior that you observed and the location of this activity.*
Comments
Should be Empty:

SEE SOMETHING. SAY SOMETHING.